The Family Doctor as the First Point of Contact (What Can a Pediatrician Do, and What Can't They Do?)

If a child seems unusually sad for an extended period, withdraws, has trouble sleeping, or faints at school, most parents first go to a pediatrician. For adolescents aged 16 and older, it’s often the family doctor. That’s the right approach. This doctor has often known the child since the first weeks of life, has followed their development, and can interpret any changes.

The doctor is the first point of contact in the healthcare system. They listen, ask about daily life, assess the child’s physical condition, and decide together with the parents whether a specialist should be consulted. In cases of persistent anxiety, low mood, behavioral changes, or problems at school, they can take the first step toward further evaluation. They also have an overview of vaccinations, pre-existing conditions, and medications that may contribute to mental health issues.

Most early detection takes place through well-child checkups, which many people know as “U” checkups. From birth through about age six, there are the U1 through U9 checkups; in addition, there are the U10 and U11 checkups during school age, as well as the J1 checkup for adolescents. Eleven of these appointments—U1 through U9 and the J1—are covered by public health insurance.

During these appointments, the doctor doesn’t just check height, weight, hearing, and vision. They also assess the child’s emotional and social development and ask about their behavior at home. This way, issues sometimes come to light before parents can even identify them themselves. The J1 checkup, for children aged about 12 to 14, is specifically tailored to puberty and provides an opportunity to discuss topics such as mood, stress, and conflicts. If you miss an appointment, you should still inquire, as the age ranges are flexible.

The pediatrician or family doctor does three main things. He or she rules out physical causes, since fatigue, concentration problems, or irritability can also be caused by thyroid issues, iron deficiency, sleep disorders, or infections. He or she makes an initial assessment of how stressed the child is and how urgently the situation needs to be addressed. And they know the ins and outs of the system—that is, which agency is responsible for which type of case.

This assessment leads to a referral. Depending on the situation, the referral goes to a practice for child and adolescent psychotherapy, a child and adolescent psychiatry (KJP) department, or a social pediatric center (SPZ) that specializes in developmental and behavioral issues. The doctor can guide the child through this process, share findings, and establish contact with the appropriate specialized services. When a diagnosis is unclear, the doctor often serves as the calm, steady presence who determines the next appropriate step.

A brief consultation is not sufficient for a mental health diagnosis. Whether a child has depression, an anxiety disorder, ADHD, or an eating disorder can only be determined through a thorough diagnostic process involving multiple consultations, standardized questionnaires, and often an assessment of the child’s school and family life. A pediatrician or family doctor cannot provide this level of depth in the course of routine practice.

The actual specialist and psychotherapeutic diagnosis is the responsibility of child and adolescent psychiatry and licensed child and adolescent psychotherapists. That is also where treatment decisions are made—such as whether treatment is appropriate and, if so, which type is best suited. The family doctor is not authorized to make a specialized psychiatric diagnosis of mental disorders or to provide psychotherapy. Their role ends with the referral and continued physical care. For parents, this is a relief because it clarifies responsibilities. A referral is often followed by a waiting period, and for many families, waiting for a therapy spot is one of the hardest parts of the journey.

Take your child to the doctor if any concerns persist for several weeks, if your child’s daily functioning has noticeably declined, or if you’re simply worried. Describe specific observations: when it started, how often it occurs, and in what situations. This helps the doctor make an assessment more than general statements do. Refusing to go to school or a sudden decline in academic performance are also good reasons to schedule an appointment.

In the event of an acute crisis, such as self-harm or talk of suicide, call the medical emergency service at 116117 or, in case of danger, dial 112. Anonymous counseling is available around the clock through “Nummer gegen Kummer” and the Telephone Counseling Service at 116 123.

Rückenwind We support parents through these phases with guidance, help them make sense of the situation, and provide a strong foundation. The actual assessment and diagnosis of a mental health issue should be handled exclusively by a child and adolescent psychiatrist or a medical or psychotherapeutic specialist.